Comparison Of Percutaneous and Intraabdominal Blockades Of Iliohypogastric and Ilioinguinal Nerves For Postoperative Pain Management Of Total Abdominal Hysterectomy Patients: A Randomized Controlled Clinical Trial

Year 2022, Volume: 44 Issue: 4, 449 - 454, 31.12.2022

Cevdet Düger Onur Avcı Abdullah Boztosun Cemil İsbir İclal Özdemir Kol Kenan Kaygusuz Sinan Gürsoy

https://doi.org/10.7197/cmj.1167647

Abstract

Objective: In this study we aimed to determine whether iliohypogastric and ilioinguinal nerve blockade from intraabdominal approach for the postoperative pain management of total abdominal hysterectomy patients could be a reliable and effective alternative compared to percutaneous block of IHII nerves.
Materials and Methods: This study is a randomised controlled double blind prospective clinical trial. This study was conducted in operating room, and recordings were performed in postoperative recovery unit and gynaecology clinic. Eighty seven women undergoing total abdominal hysterectomy were enrolled in this study but 82 completed the study. Patients were divided into three groups (n=29 in each), as control group (group C), percutaneous IHII block group (group PB) and intraabdominal IHII block group (group IB). Group C patients received no block procedure. The percutaneous bilateral IHII nerves block was performed after abdominal closure to group PB and intraabdominal IHII block was performed before abdominal closure to group IB. Mean arterial pressure, heart rate, pain scores, satisfaction scores, morphine consumptions and side effects were recorded at the 2nd, 6th, 12th and 24th postoperative hours.
Results: Postoperative MAP, HR results of control group were found similar in all groups. VAS scores at all postoperative hours were found to be significantly lower in the block groups PB an IB than control group. There were no significant differences in pain scores between group PB and IB at any time point. Morphine consumption data were found to be significantly lower in the PB and IB groups than in the control group.
Conclusions: Intraabdominal IHII blockade just before closure of the abdomen for relieving postoperative pain in total abdominal hysterectomy patients is as effective and safe method as conventional percutaneous IHII blockade without adverse effects.

Keywords

NERVE BLOCK, POSTOPERATIVE PAIN, MORPHINE, ILIOINGUINAL, ILIOHYPOGASTRIC

References

• 1. Moore KL. Clinically Oriented Anatomy, 3rd ed. Baltimore, MD: Williams & Wilkins, 1985.
• 2. Eichenberger U, Greher M, Kirchmair L, Curatolo M, Moriggl B. Ultrasound-guided blocks of the ilioinguinal and iliohypogastric nerve: accuracy of a selective new technique confirmed by anatomical dissection. Br J Anaesth. 2006; 97: 238-243.
• 3. Ganta R, Samra SK, Maddineni VR, Furness G. Comparison of the effectiveness of bilateral ilioinguinal nerve block and wound infiltration for postoperative analgesia after caesarean section. Br J Anaesth. 1994; 72: 229-230.
• 4. Kelly MC, Beers HT, Huss BK, Gilliland HM. Bilateral ilioinguinal nerve blocks for analgesia after total abdominal hysterectomy. Anaesthesia 1996; 51: 406.
• 5. Huffnagle HJ, Norris MC, Leighton BL, Arkoosh VA. Ilioinguinal iliohypogastric nerve blocks–before or after cesarean delivery under spinal anesthesia? Anesth Analg 1996; 82: 8–12.
• 6. Moote C. Efficacy of nonsteroidal anti-inflammatory drugs in the management of postoperative pain. Drugs. 1992; 44: 14-29.
• 7. Jöhr M, Sossai R. Colonic puncture during ilioinguinal nerve block in a child. Anesth Analg. 1999; 88: 1051-1052.
• 8. Vaisman J. Pelvic hematoma after an ilioinguinal nerve block for orchialgia. Anesth Analg. 2001; 92: 1048-1049.
• 9. Thibaut D, de la Cuadra-Fontaine JC, Bravo MP, de la Fuente R. Ilioinguinal/iliohypogastric blocks: where is the anesthetic injected? Anesth Analg. 2008; 107: 728-729.
• 10. Bunting P, McConachie I. Ilioinguinal nerve blockade for analgesia after caesarean section. Br J Anaesth 1988; 61: 773–775.
• 11. Bell EA, Jones BP, Olufolabi AJ, Dexter F, Phillips-Bute B, Greengrass RA, Penning DH, Reynolds JD. Iliohypogastric-ilioinguinal peripheral nerve block for post-Cesarean delivery analgesia decreases morphine use but not opioid-related side effects. Can J Anaesth. 2002; 49: 694-700.
• 12. Oriola F, Toque Y, Mary A, Gagneur O, Beloucif S, Dupont H: Bilateral ilioinguinal nerve block decreases morphine consumption in female patients undergoing nonlaparoscopic gynecologic surgery. Anesth Analg 2007; 104: 731-734.
• 13. Willschke H, Marhofer P, Bösenberg A, Johnston S, Wanzel O, Cox SG, Sitzwohl C, Kapral S. Ultrasonography for ilioinguinal/iliohypogastric nerve blocks in children. Br J Anaesth. 2005; 95: 226-230.
• 14. Wehbe SA, Ghulmiyyah LM, Dominique el-KH, Hosford SL, Ehleben CM, Saltzman SL, Sills ES. Prospective randomized trial of iliohypogastric-ilioinguinal nerve block on post-operative morphine use after inpatient surgery of the female reproductive tract. J Negat Results Biomed. 2008; 7: 11.
• 15. Owen DJ, Harrod I, Ford J, Luckas M, Gudimetla V. The surgical transversus abdominis plane block--a novel approach for performing an established technique. BJOG. 2011; 118: 24-27.